Arsenical Polyneuropathy

The neuropathy associated with arsenic ingestion presents in the context of a systemic illness. In the case of chronic poisoning, neuropathic symptoms develop slowly in the distal part of the extremities. The first symptoms are usually pain, which is aching or burning, and tingling or numbness beginning in the fingers and toes and then spreading proximally. Motor symptoms soon follow in similar distribution. Gastrointestinal symptoms may precede the polyneuropathy. Other associated symptoms include anemia, jaundice, hyper-keratosis of palms and soles, and later white transverse banding of the nails (Mees lines). Following a single, large dose of arsenic, a rapidly evolving neuropathy may appear after a period of one to three weeks. It may be preceded by severe gastrointestinal symptoms, renal and hepatic failure, and mental disturbances. The disease is accompanied by an excess of arsenic in urine, nails, and hair. Most cases recognized nowadays are following homicidal or suicidal attempts.25 A high index of suspicion is usually necessary for diagnosis. The diagnosis could be established by demonstrating high levels of arsenic in the hair or nails. Recovery from neuropathy may be very slow and the prognosis for recovery is related to the duration and severity of symptoms and success in removing the source of exposure.

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